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Non-infective left ventricular lead complications requiring re-intervention following cardiac resynchronization therapy: prevalence, causes and outcomes

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Abstract

Purpose

Left ventricular (LV) lead complications in cardiac resynchronization therapy are challenging and poorly reported. We aimed to establish prevalence, causes and outcomes of LV lead complications requiring re-intervention.

Methods

We analysed the rate of complications in 2551 consecutive patients who received a transvenous de novo LV lead as part of a cardiac resynchronization therapy device between 2000 and 2018. LV lead complications requiring re-intervention were identified; those due to infection were excluded. Patient, procedural and device characteristics, and outcomes were examined for non-infective LV lead complications requiring re-intervention.

Results

During a median of 4.7 years, 142 (5.6%) patients required re-intervention for non-infective LV lead complications with a decrease from 10.7% between 2000 and 2004, 8.7% between 2005 and 2009, 3.2% between 2010 and 2014 to 3.2% after 2014. The most common complications were LV lead displacement (50%), high pacing threshold (28%) and phrenic nerve stimulation (15%). Of the complications, 79 (56%) occurred within 90 days post-implant and 63 (44%) later. At the end of the study period, 132/142 patients (93%) had a functional LV lead. Lead re-intervention was associated with higher risk of complications (20%), but no increase in mortality (P = 0.19). Quadripolar leads had longer longevity and lower risk of complications compared with unipolar and bipolar LV leads.

Conclusions

A small but significant proportion of patients required LV lead re-intervention for complications following de novo implant. Lead displacement accounted for half of the re-interventions. Re-intervention was associated with a higher complication rate, but 92% of these patients had functional LV leads at the end of follow-up.

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References

  1. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34(29):2281–329. https://doi.org/10.1093/eurheartj/eht150.

    Article  PubMed  Google Scholar 

  2. Leon AR, Abraham WT, Curtis AB, Daubert JP, Fisher WG, Gurley J, et al. Safety of transvenous cardiac resynchronization system implantation in patients with chronic heart failure: combined results of over 2,000 patients from a multicenter study program. J Am Coll Cardiol. 2005;46(12):2348–56. https://doi.org/10.1016/j.jacc.2005.08.031.

    Article  PubMed  Google Scholar 

  3. Poole JE, Gleva MJ, Mela T, Chung MK, Uslan DZ, Borge R, et al. Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry. Circulation. 2010;122(16):1553–61. https://doi.org/10.1161/CIRCULATIONAHA.110.976076.

    Article  PubMed  Google Scholar 

  4. Palmisano P, Accogli M, Zaccaria M, Luzzi G, Nacci F, Anaclerio M, et al. Rate, causes, and impact on patient outcome of implantable device complications requiring surgical revision: large population survey from two centres in Italy. Europace. 2013;15(4):531–40. https://doi.org/10.1093/europace/eus337.

    Article  PubMed  Google Scholar 

  5. Cheng A, Wang Y, Curtis JP, Varosy PD. Acute lead dislodgements and in-hospital mortality in patients enrolled in the national cardiovascular data registry implantable cardioverter defibrillator registry. J Am Coll Cardiol. 2010;56(20):1651–6. https://doi.org/10.1016/j.jacc.2010.06.037.

    Article  PubMed  Google Scholar 

  6. van Rees JB, de Bie MK, Thijssen J, Borleffs CJ, Schalij MJ, van Erven L. Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices: a systematic review of randomized clinical trials. J Am Coll Cardiol. 2011;58(10):995–1000. https://doi.org/10.1016/j.jacc.2011.06.007.

    Article  PubMed  Google Scholar 

  7. Turagam MK, Afzal MR, Iskander S, Madhu R, Biase LD, Natale A, et al. A meta-analysis of quadripolar versus bipolar left ventricular leads on post-procedural outcomes. J Atr Fibrillation. 2016;9(2):1472. https://doi.org/10.4022/jafib.1472.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kirkfeldt RE, Johansen JB, Nohr EA, Jorgensen OD, Nielsen JC. Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark. Eur Heart J. 2014;35(18):1186–94. https://doi.org/10.1093/eurheartj/eht511.

    Article  PubMed  Google Scholar 

  9. Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sorensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449–90. https://doi.org/10.2147/CLEP.S91125.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pedersen CB, Gotzsche H, Moller JO, Mortensen PB. The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull. 2006;53(4):441–9.

    PubMed  Google Scholar 

  11. Mortensen PT, Herre JM, Chung ES, Bax JJ, Gerritse B, Kruijshoop M, et al. The effect of left ventricular pacing site on cardiac resynchronization therapy outcome and mortality: the results of a PROSPECT substudy. Europace. 2010;12(12):1750–6. https://doi.org/10.1093/europace/euq324.

    Article  PubMed  Google Scholar 

  12. Kutyifa V, Kosztin A, Klein HU, Biton Y, Nagy VK, Solomon SD, et al. Left ventricular lead location and long-term outcomes in cardiac resynchronization therapy patients. JACC Clin Electrophysiol. 2018;4(11):1410–20. https://doi.org/10.1016/j.jacep.2018.07.006.

    Article  PubMed  Google Scholar 

  13. Behon A, Schwertner WR, Merkel ED, Kovács A, Lakatos BK, Zima E, et al. Lateral left ventricular lead position is superior to posterior position in long-term outcome of patients who underwent cardiac resynchronization therapy. ESC Heart Fail. 2020;7:3374–82. https://doi.org/10.1002/ehf2.13066.

    Article  PubMed Central  Google Scholar 

  14. Gras D, Bocker D, Lunati M, Wellens HJ, Calvert M, Freemantle N, et al. Implantation of cardiac resynchronization therapy systems in the CARE-HF trial: procedural success rate and safety. Europace. 2007;9(7):516–22. https://doi.org/10.1093/europace/eum080.

    Article  CAS  PubMed  Google Scholar 

  15. Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329–38. https://doi.org/10.1056/NEJMoa0906431.

    Article  PubMed  Google Scholar 

  16. Nof E, Gurevitz O, Carraso S, Bar-Lev D, Luria D, Bachar S, et al. Comparison of results with different left ventricular pacing leads. Europace. 2008;10(1):35–9. https://doi.org/10.1093/europace/eum241.

    Article  PubMed  Google Scholar 

  17. Ahsan SY, Saberwal B, Lambiase PD, Chaubey S, Segal OR, Gopalamurugan AB, et al. An 8-year single-centre experience of cardiac resynchronisation therapy: procedural success, early and late complications, and left ventricular lead performance. Europace. 2013;15(5):711–7. https://doi.org/10.1093/europace/eus401.

    Article  PubMed  Google Scholar 

  18. Chapman M, Bates MGD, Behar JM, Williams I, Dewhurst M, Monkhouse C, et al. A novel quadripolar active fixation left-ventricular pacing lead for cardiac resynchronization therapy: initial United Kingdom experience. JACC Clin Electrophysiol. 2019;5(9):1028–35. https://doi.org/10.1016/j.jacep.2019.05.005.

    Article  PubMed  Google Scholar 

  19. Duray GZ, Israel CW, Pajitnev D, Hohnloser SH. Upgrading to biventricular pacing/defibrillation systems in right ventricular paced congestive heart failure patients: prospective assessment of procedural parameters and response rate. Europace. 2008;10(1):48–52. https://doi.org/10.1093/europace/eum259.

    Article  PubMed  Google Scholar 

  20. Lecoq G, Leclercq C, Leray E, Crocq C, Alonso C, de Place C, et al. Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure. Eur Heart J. 2005;26(11):1094–100. https://doi.org/10.1093/eurheartj/ehi146.

    Article  PubMed  Google Scholar 

  21. van Bommel RJ, Ypenburg C, Mollema SA, Borleffs CJ, Delgado V, Bertini M, et al. Site of latest activation in patients eligible for cardiac resynchronization therapy: patterns of dyssynchrony among different QRS configurations and impact of heart failure etiology. Am Heart J. 2011;161(6):1060–6. https://doi.org/10.1016/j.ahj.2011.03.014.

    Article  PubMed  Google Scholar 

  22. Sommer A, Kronborg MB, Norgaard BL, Poulsen SH, Bouchelouche K, Bottcher M, et al. Multimodality imaging-guided left ventricular lead placement in cardiac resynchronization therapy: a randomized controlled trial. Eur J Heart Fail. 2016;18(11):1365–74. https://doi.org/10.1002/ejhf.530.

    Article  PubMed  Google Scholar 

  23. Kronborg MB, Johansen JB, Riahi S, Petersen HH, Haarbo J, Jorgensen OD, et al. An anterior left ventricular lead position is associated with increased mortality and non-response in cardiac resynchronization therapy. Int J Cardiol. 2016;222:157–62. https://doi.org/10.1016/j.ijcard.2016.07.235.

    Article  PubMed  Google Scholar 

  24. Dickstein K, Bogale N, Priori S, Auricchio A, Cleland JG, Gitt A, et al. The European cardiac resynchronization therapy survey. Eur Heart J. 2009;30(20):2450–60. https://doi.org/10.1093/eurheartj/ehp359.

    Article  PubMed  Google Scholar 

  25. Buiten MS, van der Heijden AC, Klautz RJ, Schalij MJ, van Erven L. Epicardial leads in adult cardiac resynchronization therapy recipients: a study on lead performance, durability, and safety. Heart Rhythm. 2015;12(3):533–9. https://doi.org/10.1016/j.hrthm.2014.11.004.

    Article  PubMed  Google Scholar 

  26. Rademakers LM, van Gelder BM, Scheffer MG, Bracke FA. Mid-term follow up of thromboembolic complications in left ventricular endocardial cardiac resynchronization therapy. Heart Rhythm. 2014;11(4):609–13. https://doi.org/10.1016/j.hrthm.2014.01.031.

    Article  PubMed  Google Scholar 

  27. Rickard J, Johnston DR, Price J, Tedford R, Baranowski B, Bassiouny M, et al. Reverse ventricular remodeling and long-term survival in patients undergoing cardiac resynchronization with surgically versus percutaneously placed left ventricular pacing leads. Heart Rhythm. 2015;12(3):517–23. https://doi.org/10.1016/j.hrthm.2014.11.013.

    Article  PubMed  Google Scholar 

  28. Giraldi F, Cattadori G, Roberto M, Carbucicchio C, Pepi M, Ballerini G, et al. Long-term effectiveness of cardiac resynchronization therapy in heart failure patients with unfavorable cardiac veins anatomy comparison of surgical versus hemodynamic procedure. J Am Coll Cardiol. 2011;58(5):483–90. https://doi.org/10.1016/j.jacc.2011.02.065.

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the Danish Council for Independent Research (grant number 12-127221), the Central Denmark Region Research Foundation and Fabrikant Karl G. Andersens Foundation.

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Authors and Affiliations

  1. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Christoffer Tobias Witt, Mads Brix Kronborg, Jens Kristensen, Christian Gerdes & Jens Cosedis Nielsen

  2. Department of Cardiology, Trent Cardiac Centre, City Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK

    Marie Jennyfer Ng Kam Chuen

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  1. Christoffer Tobias Witt
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Correspondence to Christoffer Tobias Witt.

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Ethical approval

The study was approved by the Danish Health and Medicines Authority and the Danish Data Protection Agency.

Conflict of interest

Jens Cosedis Nielsen is supported by the Novo Nordisk Foundation (NNF16OC0018658). The other authors report no relationships that could be construed as a conflict of interest.

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Supplementary information

Table S1

(DOCX 15 kb).

Figure S1

Survival in patients with primary implantation of unipolar, bipolar or quadripolar LV lead (PNG 433 kb).

High resolution image (TIF 756 kb).

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Witt, C.T., Ng Kam Chuen, M.J., Kronborg, M.B. et al. Non-infective left ventricular lead complications requiring re-intervention following cardiac resynchronization therapy: prevalence, causes and outcomes. J Interv Card Electrophysiol 63, 69–75 (2022). https://doi.org/10.1007/s10840-021-00947-7

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  • DOI: https://doi.org/10.1007/s10840-021-00947-7

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